IBD regimens

Question 1

For Mild distal UC, what is first line therapy?

Answer 1

Topical aminosalicylates (enema/suppository)

Question 2

For mild distal UC, If first line therapy doesn’t work, what should you try next?

Answer 2

1. Oral aminosalicylate
   OR
2. Topical corticosteroids

Question 3

For mild distal UC what can be used for remission/maintenance?

Answer 3

1. Mesalamine (enema or suppository) 3x/week
2. Oral aminosalicylate to maintenance dose

Question 4

For mild EXTENSIVE UC, what is used as first line therapy?

Answer 4

1. Oral aminosalicylate
   OR
2. Oral budesonide

Question 5

For mild EXTENSIVE UC, if there’s no response to the first line therapy, what should you use?

Answer 5

Oral corticosteriod

Question 6

For mild DISTAL UC, what can be used for remission/maintenance?

Answer 6

Oral aminosalicylate at maintenance dose

Question 7

For moderate severe UC, what is used as first line? Per ACG

Answer 7

1. Oral aminosalicylate
   OR
2. Oral budesonide

Question 8

For moderate severe UC, what can you use second line per ACG?

Answer 8

Systemic corticosteroids

Question 9

For moderate severe UC, what can be used as an alternative per ACG?

Answer 9

Biologics: adalimumab, golimumab, infliximab

Question 10

For moderate severe UC, what is used as first line therapy per AGA?

Answer 10

Biologics: infliximab, golimumab, adalimumab, vedolizumab

Question 11

What are additional therapies for moderate severe UC that can be used per AGA?

Answer 11

1. Tofacitinib
2. Ustekinumab

Question 12

For moderate severe UC, you can consider combining what?

Answer 12

TNF inhibitor, vedolizumab or Ustekinumab with a thiopurine

Question 13

What can be used for remission/maintenance for moderate severe UC?

Answer 13

1. Oral aminosalicylate at maintenance dose (if responded)
2. Thiopurine (if due to corticosteroid induction)
3. TNF inhibitor or other biologic

Question 14

For severe fulminant UC, what is used as first line therapy?

Answer 14

1. IV corticosteroids

Question 15

If a patient doesn’t respond to the first line therapy of severe fulminant UC, what can be used?

Answer 15

1. Infliximab
   OR
2. IV cyclosporine

Question 16

What can be used for remission/maintenance of severe fulminant UC?

Answer 16

1. Oral prednisone (if responded to IV corticosteroids) + TNF inhibitor or biologic +/- thiopurine
2. Infliximab at maintenance dose (if responded)
3. TNF inhibitor or biologic +/- thiopurine (if responded to cyclosporine)